HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /� C
Date: S'a,—1 9 Permit Number: Y `('..-O$ o0("4
S J
`COUNTY 115CEIVf.D
.F L '0 R 1 D A ----
iiillikINIMIllilliiM111141111111, Building Permit Application MAY 21 1019
Planning and Development Services
Building and Code Regulation Division permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucre bounty
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential ✓
PERMIT TYPE:
`r PROPOSED'IMPROVEMENT LOCATION. ` , /', `
Address: 1a7Qa N in mit;»Pr off• P4 et y FL 3Y9#0
Property Tax ID#: yVPS- (p 03- Q037' 9O 0' to Lot No.
Site Plan Name: Block No.
Project Name:
';DETAILED DESCRIPTIO NOF WORK 4r
Fee!ac f ty C jc 7 .,-o/- c0✓,' lyer9to "bpi' ai/ l0 x7 /'l?1 A.";
e 5 wile dor.
CONSTRUCTION'INFORMATION. ` ->'` ,.
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers —Generator _Roof Pitch
Total Sq. Ft of Construction: _ Sq. Ft.of First Floor:
Cost of Construction:$ 9So. 0 0 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE. ` ,. ,..::; , CONTRACTOR.
Name hire6;r;„,",...% Name: Jo ft i /J t?
Address: /279? /Ow T0,; er C.71. Company: /.4-. CMi( ‘.tipet,e ,pODtS
City: pa,/,,,„ C;Ity, State:. Address:/�� !M/ 7 S7,d /kill's(ein Ave.
Zip Code: .35/9#0 Fax: — City: -t it Lu.;P State: f.
Phone No. (7707) 23 Co- IP$'T Zip Code: 3Yf '3 Fax:
E-Mail: — Phone No(77.03/70' p l PT,
Fill in fee simple Title Holder on next page(if different E-Mail dt*v'/Q 0606, Q, Lk 4fop. coolfrom the Owner listed above) State or County License 4P8'�j/3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or,more,a RECORDED Notice of Commencement is required.
'SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATIOf
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that i will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION.. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YO R LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE COMMENCEMENT."
c _....,- \� ..._--
Signa re of Own r Lessee/Contractor as Agent for Owner Signature of C ntractor/License Holder
STATE OF FLORIDA nSTATE OF FLORIDAp
COUNTY OF r Ct.LcOL_ COUNTY OF O i—L e'`e
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this0 (day of 204 by this .4.i day of /h1 - L_— ,20 ici by
oY I (open. (' Cope
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced r------C../i L Produced -i0
CiUC ' 1 - "1/4 , i
(Signature of Nota Public-St.t:Sh ...,d-. .. .. _• , .- , , (Signature of Notary Public-State of Florida)
,vv,, ELLEN VAUGHN
Commission No. •,..,A 149,., .te of F(Sda •Notary Public " Commission ;` - a,.
.011N. Commission # GG 270079 "'v'r�% ELLEN VAUGHN '
i 'l, My Commission Expires a°`� 4A��_Stete of FlorlrfA,
44,„A' October ez, 2022:. ' =* "ice *= Co misslon #rGG 2, i'ublrt }
REVIEWS + ' .�' •`, I OR PLANS „`ON M IIIRThE Ex.011 'l:f OVE
COUNTER REVIEW REVIEW REVIEW -- 'ztt_i' ,:K20-2 :RE 1 W
DATE
RECEIVED ;
DATE
COMPLETED
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